Pregnancy After Miscarriage
By Dr. Kate Dudek
Pregnancy can be a time of excitement and eager anticipation as you look forward to your new arrival. However, for some women, particularly those who have previously experienced a miscarriage, the excitement is tempered by feelings of worry, stress and anxiety. This heightened anxiety is exacerbated further in women who have experienced multiple miscarriages.
A miscarriage is defined as the spontaneous loss of a pregnancy before 20 weeks gestation. Fertilisation occurs when a sperm from the male fertilises a female’s egg. The process of human reproduction is so inefficient that only about one third of successful fertilisations will result in a live birth. Many potential pregnancies fail prior to implantation and before the female even realises that she is pregnant. Approximately 15% of clinical pregnancies (meaning an ultrasound has been used to confirm successful implantation of the fertilised egg into the wall of the uterus) end in miscarriage, usually as a result of embryo chromosomal abnormalities. It is significantly less common for a miscarriage to occur between weeks 12 and 20, so much so that many women are confident to share their news after their 12 week scan. Losses after week 12 are termed late miscarriages and occur in approximately 4% of cases.
Having one miscarriage does not usually place a woman at increased risk of having another miscarriage. However, having two or more consecutive miscarriages does increase her risk. ESHRE (the European Society of Human Reproduction and Embryology) defines recurrent miscarriage (RM) as three or more consecutive losses occurring before 20 weeks gestation. Women who experience RM have a 43% chance of experiencing further miscarriages. Approximately 1% of couples who are attempting to conceive experience RM and there can be no doubting the emotional turmoil that repeated miscarriages cause. Various factors have been associated with RM including parental chromosome abnormalities (10 times more prevalent than in the general population), immune dysfunction, endocrine disorders (thyroid conditions and PCOS), sperm damage and uterine structural abnormalities. However, the fact remains that in the majority of cases of RM, the exact cause is unknown.
In the last set of guidelines published by the World Health Organisation in 2005, it was recommended that couples wait 6 months after miscarriage before attempting to conceive again. However, more recent work has disputed this and even found that couples who fell pregnant within three months of miscarrying got pregnant faster, had a higher live birth rate (53% vs 36%) and were no more likely to experience complications, when compared to those who waited for longer than 3 months to start trying to conceive.
What is absolutely essential to consider before trying to conceive after a miscarriage is whether you are ready emotionally. Whilst your body may be physically fit, it is important to remember that you have experienced a loss and, as such, may still be grieving. Giving yourself time to heal mentally is just as important as allowing your body to recover.
In the majority of cases it is difficult to advise on how to have a successful pregnancy after miscarriage. The reasons for miscarriage are varied and, in many cases, poorly understood. Doctors do agree, however, that it is worth adopting a healthy lifestyle; increasing your folic acid intake, eating healthily, stopping smoking and reducing your alcohol intake. In combination these factors maximise your chances of both conceiving and experiencing a problem-free pregnancy.
Pregnancy after miscarriage can be a scary thing. Women who have previously miscarried are often hesitant to get excited about their next pregnancy, fearing the same outcome. The main thing is to take it a day at a time, focusing on getting to each recognised milestone; for example, the 12 week scan, the 20 week scan, the age at which the foetus becomes viable if born (approximately 23 weeks). Hopefully as you draw closer to your delivery date you will be able to start relaxing and making plans for your new arrival.
- Jauniaux, E, et al. “Evidence-Based Guidelines for the Investigation and Medical Treatment of Recurrent Miscarriage.” Human Reproduction, vol. 21, no. 9, Sept. 2006, pp. 2216–2222., doi:10.1093/humrep/del150.
- Larsen, E C, et al. “New Insights into Mechanisms behind Miscarriage.” BMC Medicine, vol. 11, no. 154, 26 June 2013, doi:10.1186/1741-7015-11-154.
- “Pregnancy after Miscarriage: What You Need to Know.” Mayo Clinic, 12 Mar. 2019, www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134.
- Schliep, K C, et al. “Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait.” Obstetrics and Gynecology, vol. 127, no. 2, Feb. 2016, pp. 204–212., doi:10.1097/AOG.0000000000001159.
- World Health Organization Report of a WHO technical consultation on birth spacing, Geneva Switzerland 13-15 June 2005. Available at: http://www.who.int/maternal_child_adolescent/documents/birth_spacing.pdf. Accessed 06/05/2019.